Dr. Jeff Hersh: Overlapping symptoms can confuse

Monday

I am going through menopause and sometimes I feel my heart beat fast and I get hot flashes. How can I tell if this is from menopause or from a heart attack?

Q: I am going through menopause and sometimes I feel my heart beat fast and I get hot flashes. How can I tell if this is from menopause or from a heart attack?

A: The average age of menopause is 51, although some women have it earlier, and 5 percent of women have it after age 55. The average age of women having a heart attack is 70. However, some women do have heart disease at much younger ages than this, especially those with risk factors of heart disease including diabetes, high blood pressure, high cholesterol, family history of early heart disease, smoking, being overweight or a sedentary lifestyle.

There are lots of misconceptions about heart disease in women. Some people think only men have heart disease; only 10 percent to 15 percent of women think heart disease is a threat for them. The reality is that heart disease is the leading killer of both men and women in the U.S., claiming a woman's life every minute.

The "typical" symptoms of a heart attack (also called a myocardial infarction or MI) are crushing chest pain radiating to the arm and/or jaw, associated with shortness of breath and sweating.

These symptoms are actually not so typical, and are much less common in women than men. In fact, less than 30 percent of women report having had chest pain prior to their MI, and 40 percent or more never have chest pain, even during their MI.

So, what symptoms do women "usually" have?

Many women have prodromal symptoms; that is symptoms up to a month or more prior to having an MI. These "warning" symptoms include:

- Unusual fatigue in as many as 70 percent.

- Sleep disturbance in 50 percent.

- Shortness of breath in more than 40 percent.

- A feeling of "indigestion" in 40 percent.

- Anxiety in more than 35 percent.

During an acute MI, many women have "atypical" symptoms such as:

- A hot/burning sensation, even tender to the touch, in their back, shoulders, arms or lower jaw (note these are above the waist and do not include the legs).

- Shortness of breath.

- Acute overwhelming fatigue.

- Severe nausea, sometimes with vomiting.

- An indigestion feeling.

- Dizziness, sometimes even fainting.

- Weakness in the arms.

- A sudden feeling of anxiety, panic or impending doom.

- Sometimes chest pain and other "typical" symptoms

Menopause is defined as a cessation of menses for 12 months, beginning with irregular menses even before the periods stop. Symptoms can begin prior to menopause, and for some women can last years afterward.

Symptoms include:

- Hot flashes in more than 75 percent, typically starting in the face and chest and then becoming generalized, usually lasting 2 to 5 minutes. These symptoms may be accompanied by palpitations (a feeling of heart racing), sweating and anxiety, and are more common at night.

- Sleep disturbances, usually due to episodes of hot flashes.

- Fatigue, depression, vaginal dryness and others.

Comparison of these is interesting. Prodromal heart disease symptoms of fatigue, sleep disturbance and anxiety overlap menopause symptoms. The MI symptoms of fatigue, anxiety, sweating and a "hot/burning" sensation are similar to menopausal symptoms.

With this huge overlap, how can a woman differentiate what is happening to her? The clues come from what her usual menopausal symptoms are and their details. For example, hot flashes that start all over the face and become generalized may be able to be differentiated from MI symptoms that usually affect only the lower jaw and not the legs.

Sleep disturbances from menopause are usually due to episodes of hot flashes. The fatigue from menopause is usually more chronic. The average age of menopause (approximately 51) is much younger than for heart disease in women (approximately 70). Finally, heart disease is more common in women with risk factors for it, especially at younger ages.

Note the use of "usually" and "may" in the preceding paragraph. Since heart disease is the No. 1 cause of death of women and "atypical" symptoms are common, a high index of suspicion is important.

Symptoms of menopause or prodromal heart disease - or other concerning symptoms - should be discussed with your health-care provider. For some women, especially those with risk factors of early heart disease, tests to stratify these risks - such as a stress test - may be indicated.

If you have symptoms that may be indicative of an acute MI you should call 911 and go directly to the emergency room. If your symptoms are due to a heart attack, early treatment is key to minimize permanent heart damage and to improve outcome.